When do we eat? An evaluation of food items input into an electronic monitoring application

We present a formative study that examines what, when, and how participants in a chronic kidney disease (stage 5) population input food items into an electronic intake monitoring application. Participants scanned food item barcodes or voice recorded food items they consumed during a three week period. The results indicated that a learning curve was associated with barcode scanning; participants with low literacy skills had difficulty describing food items in voice recordings; and participants input food items depending on when they had dialysis treatment. Participants thought this electronic self monitoring application would be helpful for chronically ill populations in their first year of treatmen

Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills

Chronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy- accessible liquid portion size estimation mobile interface

How effects on health equity are assessed in systematic reviews of interventions.

BACKGROUND: Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009.  The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.  OBJECTIVES: To systematically review methods to assess effects on health equity in systematic reviews of effectiveness. SEARCH STRATEGY: We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010. SELECTION CRITERIA: We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. DATA COLLECTION AND ANALYSIS: Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.  MAIN RESULTS: Thirty-four methodological studies were included.  The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1).  Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility. AUTHORS' CONCLUSIONS: There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews

Digital Bridges Across Disciplinary, Practical and Pedagogical Divides: An Online Professional Master’s Program in Heritage Resource Management

Growth and diversification in heritage resource management (HRM) archaeology since the 1960s have created new demands for training the next generations of HRM leaders and for addressing persistent and counterproductive divisions between academic and applied archaeologies. The Simon Fraser University Department of Archaeology (SFU) has responded to these demands with an all-new, cohort-based, thesis-focused graduate program created by and for HRM professionals. The program’s target audience is HRM practitioners who hold Bachelor’s credentials, have initiated promising careers in HRM, and desire advanced, research-focused degrees to enable their professional capacity and upward mobility. The SFU program is structured and focused to provide intensive, predominantly online training in the four essential dimensions of HRM: law and policy, ethics and practice, business management, and research design and methods. The program has been successful through initial cohort cycles and in attracting HRM industry interest in collaboration. Industry-academic partnerships in cognate disciplines have proved effective in comparable circumstances but remain underdeveloped as bases for planning and delivering state-of-the-art training in applied archaeology and the broader field of HRM. Critical next steps in program development entail the identification of attributes of HRM futures desired by all or most HRM stakeholders and the collaborative pursuit of those desired futures

A pilot observational study measuring acute sarcopenia in older colorectal surgery patients

Abstract Objective To explore variability in acute changes in muscle mass and function in older patients undergoing elective colorectal surgery, as well as feasibility of measures, in order to refine study processes to inform the protocol for a larger study. Results Results are presented for seven participants recruited to this pilot study. It is possible to perform serial measurements of bilateral anterior thigh thickness (BATT) and handgrip strength prior to, within 24 h of surgery, and 1 week postoperatively. Gait speed can be reliably measured preoperatively and at 1 week postoperatively. In this pilot study, BATT and gait speed declined at 1 week postoperatively (median BATT 4.17 cm, 3.47 cm, p = 0.028; median gait speed 0.89 m/s, 0.83 m/s, p = 0.043). Baseline hsCRP correlated with change in BATT (τb = 0.73, p = 0.04) and baseline DHEA-S correlated with change in gait speed (τb = 0.87, p = 0.02). This pilot study has assisted to refine the protocol for our larger study, which will further characterise these changes

GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence

Objectives: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting: Consensus-based guidance developed by the GRADE working group members and other methodologists. Results: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society

Systematic review of health-related quality of life models

BACKGROUND: A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models. METHODS: Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria. RESULTS: Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice. CONCLUSIONS: Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL

Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation

Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS: This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION: We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health

Period and chemical evolution of SC stars

The SC and CS stars are thermal-pulsing AGB stars with C/O ratio close to unity. Within this small group, the Mira variable BH Cru recently evolved from spectral type SC (showing ZrO bands) to CS (showing weak C2). Wavelet analysis shows that the spectral evolution was accompanied by a dramatic period increase, from 420 to 540 days, indicating an expanding radius. The pulsation amplitude also increased. Old photographic plates are used to establish that the period before 1940 was around 490 days. Chemical models indicate that the spectral changes were caused by a decrease in stellar temperature, related to the increasing radius. There is no evidence for a change in C/O ratio. The evolution in BH Cru is unlikely to be related to an on-going thermal pulse. Periods of the other SC and CS stars, including nine new periods, are determined. A second SC star, LX Cyg, also shows evidence for a large increase in period, and one further star shows a period inconsistent with a previous determination. Mira periods may be intrinsically unstable for C/O ~ 1; possibly because of a feedback between the molecular opacities, pulsation amplitude, and period. LRS spectra of 6 SC stars suggest a feature at wavelength > 15 micron, which resembles one recently attributed to the iron-sulfide troilite. Chemical models predict a large abundance of FeS in SC stars, in agreement with the proposed association.Comment: 14 pages, 20 figures. MNRAS, 2004, accepted for publication. Janet Mattei, one of the authors, died on 22 March, 2004. This paper is dedicated to her memor

Competing Pathways in the Photochemistry of Ru(H)2(CO)(PPh3)3

The photochemistry of Ru(H)2(CO)(PPh3)3 (1) has been reinvestigated employing laser and conventional light sources in conjunction with NMR spectroscopy and IR spectroscopy. The sensitivity of NMR experiments was enhanced by use of p-H2-induced polarization (PHIP), and a series of unexpected reactions were observed. The photoinduced reductive elimination of H2 was demonstrated (a) via NMR spectroscopy by the observation of hyperpolarized 1 on pulsed laser photolysis in the presence of p-H2 and (b) via nanosecond time-resolved infrared (TRIR) spectroscopy studies of the transient [Ru(CO)(PPh3)3]. Elimination of H2 competes with photoinduced loss of PPh3, as demonstrated by formation of dihydrogen, triphenylarsine, and pyridine substitution products which are detected by NMR spectroscopy. The corresponding coordinatively unsaturated 16-electron intermediate [Ru(H)2(CO)(PPh3)2] exists in two isomeric forms according to TRIR spectroscopy that react with H2 and with pyridine on a nanosecond time scale. These two pathways, reductive elimination of H2 and PPh3 loss, are shown to occur with approximately equal quantum yields upon 355 nm irradiation. Low-temperature photolysis in the presence of H2 reveals the formation of the dihydrogen complex Ru(H)2(η2-H2)(CO)(PPh3)2, which is detected by NMR and IR spectroscopy. This complex reacts further within seconds at room temperature, and its behavior provides a rationale to explain the PHIP results. Furthermore, photolysis in the presence of AsPh3 and H2 generates Ru(H)2(AsPh3)(CO)(PPh3)2. Two isomers of Ru(H)2(CO)(PPh3)2(pyridine) are formed according to NMR spectroscopy on initial photolysis of 1 in the presence of pyridine under H2. Two further isomers are formed as minor products; the configuration of each isomer was identified by NMR spectroscopy. Laser pump-NMR probe spectroscopy was used to observe coherent oscillations in the magnetization of one of the isomers of the pyridine complex; the oscillation frequency corresponds to the difference in chemical shift between the hydride resonances. Pyridine substitution products were also detected by TRIR spectroscopy